Prostate Biopsy

(Transrectal Biopsy; Transurethral Biopsy; Transperineal Biopsy)

Definition

A prostate biopsy is the removal of a small amount of tissue from the prostate gland. The tissue is examined for the presence of cancer cells.

Prostate Cancer

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Reasons for Procedure    TOP

A prostate biopsy is usually done after an abnormal finding by:

  • Digital rectal exam
  • Prostate specific antigen (PSA) blood test

A prostate biopsy is the only way to find out if cancer cells are present.

Possible Complications    TOP

Problems from the procedure may occur, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Bruising or lengthy bleeding from the rectum, or in urine or semen
  • Difficulty urinating
  • Reactions to anesthesia

Factors that may increase the risk of complications include:

  • Smoking
  • History of bleeding disorders or easy bruising
  • Use of any medications, over-the-counter medications, or herbal supplements
  • Sensitivity or allergy to latex, medications, or anesthesia

What to Expect    TOP

Prior to Procedure

You may be asked to do the following:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Begin taking an antibiotic.
  • Use an enema several hours before the procedure.
  • If you will be getting general anesthesia, do not eat or drink anything after midnight.

Anesthesia

The type of anesthesia depends on the method that your doctor uses:

  • Transurethral biopsy and perineal biopsy:
    • General anesthesia—Blocks pain and keeps you asleep through the surgery. This will be used for a transrectal prostate biopsy.
    • Local anesthesia—Just the area that is being operated on is numbed, given as an injection and may also be given with a sedative.

Description of the Procedure    TOP

Your doctor will use one of the following methods to do the biopsy:

  • Transrectal biopsy (most common method)—Your doctor will insert a small ultrasound device into the rectum. This device will produce sound waves to create an image of the prostate. These images will help guide placement of the needle. Your doctor will then insert the needle through the wall of the rectum and into the prostate gland.
  • Transurethral biopsy—Your doctor will insert a lighted flexible tube through the tip of the penis and into the urethra. The urethra carries urine from the bladder. Your doctor will get the biopsy with a cutting loop that is passed through the flexible tube.
  • Perineal biopsy—Your doctor will make a small incision in the perineum. The perineum is the area between the scrotum and the rectum. The doctor will insert a small needle into the prostate gland to get the biopsy.

How Long Will It Take?    TOP

About 30 minutes

Will It Hurt?    TOP

You may have discomfort and soreness at the biopsy site. Pain and discomfort after the procedure can be managed with medications.

Postoperative Care    TOP

Blood in the urine, stool, or semen is normal. This may last several days. You may be advised to avoid strenuous activity a day or two after the procedure. Follow your doctor's instructions on caring for the biopsy site.

After the sample is taken, it will be sent to a pathologist for examination under a microscope. If cancer is present, your doctor will work with you to develop a treatment plan.

Call Your Doctor    TOP

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Inability to urinate
  • Blood in the urine more than 2-3 days post-biopsy
  • Signs of infection, including fever and chills
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency, or frequency of urination
  • Cough, shortness of breath, or chest pain
  • Rectal bleeding that lasts more than 2-3 days after the biopsy

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Cancer Institute
https://www.cancer.gov
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Prostate Cancer Canada
http://www.prostatecancer.ca

References:

Prostate biopsy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905693/Prostate-biopsy. Updated April 28, 2017. Accessed October 10, 2016.
Rodriguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol. 1998;160(6-I):2115-2120.
Tests for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated May 15, 2017. Accessed October 10, 2017.
Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis. 2007;10(2):127-136.
Understanding prostate changes: A health guide for men. National Cancer Institute, National Institutes of Health website. Available at: https://www.cancer.gov/types/prostate/understanding-prostate-changes. Accessed October 10, 2017.
What causes prostate cancer? Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed October 10, 2017.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
7/13/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905693/Prostate-biopsy: Gershman B, Van Houten HK, Herrin J, et al. Impact of prostate-specific antigen (PSA) screening trials and revised PSA screening guidelines on rates of prostate biopsy and postbiopsy complications. Eur Urol. [Epub ahead of print] 2016 Mar 16.
Last reviewed September 2017 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 7/13/2016

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